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2010 NESCH
Advanced Workshop Registration Form
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Name/Degree: |
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Professional Specialty: |
| Institutional
Affiliation: |
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Address: |
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City, State, ZIP: |
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Telephone (Office): |
| Telephone
(Cell): |
| Telephone
(Home): |
E-mail Address: |
|
o |
NESCH Member
..................................................................................... |
$350. |
| o |
Member
of ASCH, SCEH, ISH.................................................................. |
$375. |
| o |
Non-Member........................................................................................... |
$425. |
| Amount
Enclosed ( U.S. dollars
): |
Please print out the form above and, with your
check made out to NESCH, mail to:
NESCH Advanced Workshop
41
Woodbury Rd
Southborough MA 01772
May 1-2, 2010
Newton-Wellesley Hospital
Shipley Auditorium
2014 Washington Street
Newton,
MA 02462
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Questions to: WorkshopInfo@nesch.org
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Comments about the Website are welcome.
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